227 The Spectrum, Management, and Outcomes of Upper GI Emergencies Presenting to a Tertiary Upper GI Cancer Centre.

Abstract Background Upper gastrointestinal (UGI) emergencies represent a diverse group of acute presentations that can be life-threatening and require prompt multidisciplinary intervention. As the national referral centre for oesophageal and gastric cancers, our institution manages not only routine emergencies, but also complex cases influenced by malignancy, prior treatment, and tertiary referrals. This context may impact presentation, decision-making, and outcomes. Aim To evaluate the spectrum, management strategies, and clinical outcomes of UGI emergencies admitted to a national tertiary UGI cancer centre between January 2019 and December 2024. Method A retrospective observational study was conducted including all patients emergently admitted with perforated oesophagus, gastric outlet obstruction (GOO), diaphragmatic hernia, intestinal perforation, UGI bleeding, foreign body ingestion, or oesophageal burn. Data on demographics, referral source, management, length of stay, morbidity, and mortality were analysed. Results 1520 patients were admitted during the study period. 909 were male (59.8%) and 611 female (40.2%), with a mean age of 61 years. 364 (23.9%) represented weekend admissions. The mean length of stay was 9.4 days. Most common presentations were UGI bleeding (1042, 68.6%), foreign body ingestion (178, 11.7%), acute diaphragmatic hernia (152, 10%), intestinal perforation (69, 4.5%), GOO (40, 2.6%), perforated oesophagus (38, 2.5%), and oesophageal burn (1, 0.1%). Conclusions UGI emergencies at a national cancer referral centre represent a broad and complex case mix. UGI bleeding was the most frequent presentation, but high-acuity cases such as acute diaphragmatic hernia and oesophageal perforation reflect the specialist nature of referrals and highlight the need for tailored emergency care.